This application addresses the National Center on Minority Health and Health Disparities'(NCMHD's) Social Determinants of Health Initiative high priority area for funding under the NIH Research and Research Infrastructure Grand Opportunity. The project is a collaborative effort between the University of Maryland School of Medicine (UMSOM), its established educational partners-Eastern Shore Area Health Education Center (ESAHEC) located in rural Eastern Shore Maryland and the Western Maryland Area Health Education Center (WMAHEC) located in rural Western Maryland, and its rural health care delivery partners- Garrett County Health Department Home Health Agency (GCHDHHA, in rural Western Maryland) and the Chesapeake Potomac Home Health Agency (CPHHA, in rural Southern Maryland). The broad goals of the project are to reduce disparities, within the broad context of social determinants of health, in chronic disease management among minority, low-income white, and medically underserved patients residing in rural geographies by building an innovative telehome care (THC) capacity and generating theoretically-based, scientifically rigorous and high quality evidence on the ability of the technology to enhance access to specialty care, improve clinical outcomes, and positively impact medical resource utilization in rural and medically underserved communities. With these broad goals, the project aims to refocus attention and resources towards high value translational research approaches that help transform health care practices using novel technologies. The specific aims are: (1) To use a cross-over, prospective cohort design to test the efficacy of a structured 90 day time-limited THC program to enhance access to evidence based best practices in the clinical management of Metabolic Syndrome/Diabetes Mellitus (DM), Chronic Heart Failure (CHF), Hypertension (HTN), and Chronic Obstructive Pulmonary Disease (COPD);(2) To evaluate the impact of this 90 day time-limited THC program on medical resource utilization and effects on Quality of Life;and, (3) To evaluate a patient and health care professional education program on THC to enhance acceptability and satisfaction. The project, guided by the socioecological theory of health and the community based participatory framework, will be implemented in rural Western and Southern Maryland counties among 250 eligible patients receiving home health care through GCHDHHA and CPHHA. Informed by the social determinants of health and the socioecological theory of health, the project's measures examine, besides individual-level factors, social/ interpersonal, community/institutional, and societal factors and their relationships to chronic diseases and its management. The patients will be assessed at baseline, 30-days, and 90-days on medication history, number of emergency department visits and/or hospitalizations, and Quality of Life. The analytical strategy includes the use of summary measures, repeated measure ANOVA, and generalized estimating equations. The project also has a rigorous process evaluation component to monitor and triangulate delivery of the THC program. Benefits of the project include the preservation of 12 jobs and creation of 14 new jobs, the promotion of economic recovery among rural communities in Maryland, and insights into the applicability of e-health technologies in the cost-effective management of chronic diseases. With the focus on rural populations facing serious health disparities, evidence of improved access to care and clinical outcomes will prove to be an invaluable investment towards us achieving the national priority of elimination of health disparities within the multi-factorial social determinants of health perspective. The project will have an impact on our understanding of the ability of cost-efficient technologies to deliver high quality medical specialty care to rural settings, thus reducing chronic disease management disparities among the minorities, low-income white, and the medically underserved residing in rural settings.